Clinically Simple Cutaneous Leishmaniasis When Systemic Antileishmanial Therapy Has Not Met Response Goals
Clinical scenario
This protocol addresses immunocompetent patients with cutaneous leishmaniasis classified as clinically simple — a single or a few small skin lesions (diameter less than 1 cm) on nonexposed skin, caused by a Leishmania species not associated with mucosal disease, with no mucosal involvement.
Previous treatment — insufficient response
The prior course consisted of systemic antileishmanial therapy. That treatment did not achieve the expected response:
- Lesion size had not decreased by more than 50% at 4–6 weeks after treatment
- Ulcerative lesions were not reepithelializing at 4–6 weeks
- New lesions appeared, or lesions were not fully healed by approximately 3 months
This protocol defines the next step taken after that failure.
Next-step treatment approach
Additional antileishmanial therapy is indicated. The structured protocol specifies whether to repeat the same agent, change to a different approach, or use a combination strategy — including the option of pairing a local antiparasitic intervention with a physical modality. The complete sequencing, agent selection, and response criteria are in the full protocol.
References
DOI: 10.1093/cid/ciw670
- We recommend that immunocompetent persons with skin lesions that are caused by infection with Leishmania species that are not associated with increased risk for ML, that are defined as clinically simple lesions (Table 1), and that are healing spontaneously may be observed without treatment if the patient concurs with this management.
- Local therapy is preferred for treatment of Old World cutaneous leishmaniasis (OWCL) lesions defined as clinically simple (Table 1) and may be useful for localized NWCL caused by Leishmania species not associated with increased risk for ML.
- Additional therapy is recommended (but not necessarily always with a different agent or approach) when there is development of new skin lesions or worsening of existing lesions.
- For some patients, combination therapy may be an option — for example, with 2 antiparasitic agents, an antiparasitic plus a physical modality (such as with IL SbV plus cryotherapy), or an antiparasitic plus an immune modulator.
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